- Paperback: 288 pages
- Publisher: Picador; 1st edition (January 22, 2008)
- Language: English
- ISBN-10: 0312427654
- ISBN-13: 978-0312427658
- Product Dimensions: 5.6 x 0.8 x 8.2 inches
- Shipping Weight: 9.6 ounces (View shipping rates and policies)
- Average Customer Review: 412 customer reviews
- Amazon Best Sellers Rank: #7,549 in Books (See Top 100 in Books)
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achieving handwashing by healthcare workers to reduce the spread of infections,
attempts to erradicate polio in India by chasing hotspots,
reducing mortality in the Iraq/Afghanistan wars by new strategies of battlefield care,
aspects of chaperones for intimate physical examinations,
different systems for physician compensation,
ways to reform our malpractice laws,
the inhumaness of execution methods and the ethics that prevent physicians from participating,
development of Apgar scores and how they have reduced newborn mortality,
and examples of how doctors and facilities that are highly specialized show better outcomes.
The author explores how significant innovations have been made by those who investigate new approaches and are committed to improvement and how we should all strive to make improvements within our personal niche in healthcare. "How to Become a Positive Deviant"
On Washing Hands very crucial in hospital environment, Doctors, Nurses and staff need to wash their hands constantly to help stop the spread of infection. Each year two million Americans acquire an infection while they are in the hospital. That's just the tip of the iceberg.
I believe, a Surgeon's Notes on Performance, it is important for all of us to read. Especially, if you are planning on staying in the hospital for any length of time. Atul Gawande touched on so many important issues. I think, some reviewers gave elegant reviews. The reviewers are the ones, basically, sold me on getting this book. I' am so happy, I had the opportunity to read it. At the end of the book there are excellent Notes on Sources.
Under diligence, he describes how simple persistence can improve performance significantly. For example, simple compliance with washing hands before and after each interaction with a patient would reduce unnecessary infections greatly and yet it is one of the poorest areas of performance in many medical establishment. My wife had a baby a couple weeks ago at a well-respected New York City hospital (that shall remain nameless) and, having read this book, I couldn't help but watch the hand washing. Though there was hand-washing going on, my anecdotal results were somewhat disappointing. It's scary. And yet, his stories of the effort to send polio the way of smallpox and the amazing success rates of medical teams in Iraq through no more than basic diligence with well-established methods give readers hope.
Under doing right, Gawande tells stories of the continuing debate over what constitutes right and wrong in medicine. What is the proper way to interact with someone who you have to examine naked? When is it fair to sue a doctor and how much is it worth? What should a doctor be paid for their services? Should a doctor participate in executions at prisons, considering the methods we use now are basically medical? When should a doctor continue treatment at all costs or let a patient die? These are questions with no easy answers and Gawande takes a balanced approach.
Under ingenuity, he discusses some simple, clever ideas that have helped improve performance in various areas. His wonderful chapter on childbirth focuses on the Apgar score for newborns. As most know, this is a number ubiquitous now at the birth of a baby. It wasn't even developed by an OB/GYN. It was developed by an anaesthesiologist. It required no new medical techniques. It simply required doctors and nurses to do a directed assessment of a baby at birth. And yet, this simple, ingenious change, dropped child mortality rates significantly as babies previously thought to have no chance were given a chance and hospitals competed to "improve" their Apgar scores. In this section he also has a discussion on how true analysis of doctor and hospital performance is rare but, when used, greatly improves success as well as a discussion of the amazing cleverness of doctors in the poorest parts of the world to do procedures with limited equipment. It was incredibly eye-opening.
It is a fact of life that all of us will have to encounter the medical establishment from time to time. It can be incredibly frustrating. Still, it's nice to know that there are doctors like Gawande trying to understand things and make them better. In addition, he is a fine writer who has a wealth of interesting history and personal anecdotes that help make his ideas clear. Everyone should take some time and read his work.